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Organization

SOUTHEASTERN REGIONAL MEDICAL CENTER

Active
Other names
Johnson Medical Clinic
Organization subpart
No

Provider details

NPI number
Authorized official
CHARLES THOMAS JOHNSON III (CFO)
(910) 671-5090
Entity
Organization

Contact information

Practice address
222 S MAIN ST, RED SPRINGS, NC 28377-1622
(910) 843-4576
(910) 843-2301
Mailing address
2600 N ELM ST, LUMBERTON, NC 28358-3011
(910) 272-3051
(910) 738-3764

Taxonomy

Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
H0064
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0185K
BLUE CROSS BLUE SHIELD
NC
05
343415A
NC
05
343415C
NC
Enumeration date
08/18/2005
Last updated
01/27/2009
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